Pre-augmentation soft tissue expansion: An overview

Objectives: The aim of this study was to explore the development of soft tissue expanders, their different types and their potential applications prior to bone augmentation and implant placement. Material and Methods: A review of pertinent literature was performed using PubMed to comprehend the dynamics of soft tissue expanders and determine the current position of their pre-augmentation applications. Results: There is promising, albeit preliminary information regarding the benefits of pre-augmentation soft tissue expansion. Findings cannot be generalised due to relatively small sample size. Conclusions: Further clinical trials with larger sample sizes and long-term follow-up are needed before soft tissue expanders can be confidently applied in everyday clinical practice

Stair ascent and descent in assessing donor site morbidity following osteocutaneous free fibula transfer : a preliminary study

Purpose: We wanted to investigate the gait kinematic parameters during stairs ascent and descent after a fibula free flap (FFF) removal for facial reconstruction. Methods: Eight patients who underwent facial reconstruction with FFF ascended and descended three standard steps. Their movements were recorded by a motion analyzer; gait kinematic parameters were obtained and compared to those calculated in eight control subjects. Results: Stride time, percentage of swing and support phases did not differ among healthy or operated limb, and control subjects (Kruskal Wallis, p>0.05). No significant differences were found for hip and knee movements, pelvis rotation and tilt, and body center of mass displacements. During stair descent, the patients had a significantly larger pelvis inclination than the control subjects (p<0.05). Conclusion: No functional limitations during stair performance were found. The only significant difference could indicate a minor control of the pelvis, and should be used to define specific rehabilitative interventions

Digital device in postextraction implantology : a clinical case presentation

Aim. The aim of this work is to describe a case of immediate implant placement after extraction of the upper right first premolar, with the use of CAD/CAM technology, which allows an early digital impression of the implant site with an intraoral scanner (MHT 3D Progress, Verona, Italy). Case Report. A 46-year-old female was referred with a disorder caused by continuous debonding of the prosthetic crown on the upper right first premolar. Clinically, there were no signs, and the evaluation of the periapical radiograph showed a fracture of the root, with a mesial well-defined lesion of the hard tissue of the upper right first premolar, as the radiolucent area affected the root surface of the tooth. It was decided, in accordance with the patient, that the tooth would be extracted and the implant (Primer, Edierre implant system, Genoa, Italy) with diameter of 4.2mm and length of 13mm would be inserted. After the insertion of the implant, it was screwed to the scan abutment, and a scan was taken using an intraoral scanner (MHT 3D Progress, Verona, Italy). The scanned images were processed with CAD/CAM software (Exocad DentalCAD, Darmstadt, Germany) and the temporary crown was digitally drawn (Dental Knowledge, Milan, Italy) and then sent to the milling machine for production with a composite monoblock. After 4 months, when the implant was osteointegrated, it was not necessary to take another dental impression, and the definitive crown could be screwed in. Conclusion. The CAD/CAM technology is especially helpful in postextraction implant for aesthetic rehabilitation, as it is possible to immediately fix a provisional crown with an anatomic shape that allows an optimal healing process of the tissues. Moreover, the removal of healing abutments, and the use of impression copings, impression materials, and dental stone became unnecessary, enabling the reduction of the chair time, component cost, and patient's discomfort. However, it is still necessary for scientific research to continue to carry out studies on this procedure, in order to improve the accuracy, the reliability, and the reproducibility of the results

Evaluation of three-dimensional mandibular movements after reconstruction with free fibula flap

In questo studio sono stati analizzati sette pazienti a cui \ue8 stata ricostruita la mandibola utilizzando un lembo libero di fibula. Un paziente \ue8 stato operato medialmente e gli altri sul lato destro o sinistro. I pazienti sono stati riabilitati con protesi su impianti, ed hanno eseguito una serie di movimenti limite mandibolari (massima apertura e chiusura della bocca, laterotrusioni destra e sinistra, protrusione), che sono stati registrati nelle tre dimensioni dello spazio da un sistema non invasivo di analisi del movimento. I relativi parametri cinematici dell\u2019articolazione temporomandibolare sono stati confrontati con quelli ottenuti in un gruppo di soggetti sani di controllo utilizzando gli z-score. La massima apertura della bocca \ue8 risultata ridotta in tutti i pazienti, con z-scores compresi tra -2.742 e -0.106, ed \ue8 stata effettuata con una minore rotazione mandibolare sul piano sagittale. In tutti i pazienti salvo uno si \ue8 rilevata una riduzione del movimento del punto interincisale durante la protrusione. Nei pazienti, i movimenti del punto interincisivo in laterotrusione e i movimenti condilari durante l\u2019apertura della bocca sono risultati molto variabili e talvolta asimmetrici. Anche la rotazione mandibolare \ue8 risultata molto variabile, con z-scores compresi tra -1.265 e - 1.388. Insieme all\u2019ampiezza dei movimenti, sono state indagate alcune caratteristiche biomeccaniche dell\u2019articolazione, che possono fornire informazioni relativamente ai capi articolari senza sottomettere i pazienti a procedure pericolose. Le valutazioni possono essere eseguite longitudinalmente durante il follow-up. I dati forniti da questo studio indicano quali aree facciali e quali strutture devono essere attentamente valutate durante la pianificazione preoperatoria, nell\u2019illustrazione dei problemi al paziente e durante la riabilitazione.Seven patients who underwent mandibular reconstruction with a fibula free flap (one on the midline, six on either right or left side) and were rehabilitated with implant supported prostheses, performed free mandibular border movements (maximal mouth opening and closing, right and left lateral excursions, protrusion) that were recorded by a non-invasive motion analyser. Temporomandibular joint (TMJ) kinematic parameters were compared to those calculated in healthy control subjects using z-scores. Maximum mouth opening was reduced in all patients, with z-scores ranging from -2.742 to -0.106, and performed with a reduced sagittal plane mandibular rotation. Interincisal point forward movement during protrusion was reduced in all but one patient. Lateral mandibular movements (displacement of the interincisal point) and bilateral condylar movements during mouth opening were very variable and sometimes asymmetrical. Mandibular rotation was also variable, with z-scores ranging from -1.265 to 1.388. Together with mandibular range of motion, we investigated biomechanical characteristics of TMJ motion that can provide further information about the joint without submitting the patient to harmful procedures, and that can be followed-up during healing. The investigation indicates those areas that need to be given special attention in preoperative planning, patient information and rehabilitation

Immunoexpression of cytokeratin-19 in the oral lichen planus and related oral squamous cell carcinoma

AIMS: Cytokeratin 19 (CK-19) is an epithelium-specific intermediate filament protein that has been investigated in oral lichen planus (OLP) lesions but has not been compared with the expression of CK-19 in the OLP-related oral squamous cell carcinoma (OSCC). The aim of the present study has been to objectively compare the immunohistochemical expression of the CK-19 in OLP lesions and subsequent OSCC lesions that developed over time, to evaluate the change of the staining pattern among OLP and the grades of differentiation in OSCC. METHODS: Thirty-six formalin-fixed tissues of 18 OLP patients (18 samples from OLP lesion and 18 samples from OLP-related OSCC lesion) were included. The monoclonal antibody for CK-19 was used at 1:100 dilution for the immuno-staining on 4-\u3bcm thick sections. Staining pattern of CK-19 was graded into a 4-point scale: (1) no staining, (2) only few cells staining, (3) less than 50% of the cells stained, and (4) 50% or more of the cells stained. Microslides were examined under the light microscope using objective lenses magnifications of 4 7, 10 7, and 20 7. RESULTS: The CK19 positive rate in OLP tissues was 33% (6 out of 18) and 56% (10 out of 18) in OSCC tissues. The CK19 positive score in OSCC tissues was significantly higher than that in the corresponding OLP tissues (Mann-Whitney test, P=0.02). Well-differentiated OSCC showed significantly lower of C-K19 scores than those moderately differentiated grades (Mann-Whitney, P=0.007). CONCLUSIONS: The quantity and distribution of CK-19 staining in OSCCs showed relevant difference in comparison with OLP lesions. The increased of CK19 protein expression in OSCC tissues correlates significantly with the pathologic differentiation grade